Presentation on theme: "CT - Anatomy and Pathology of Uterus and Ovaries"— Presentation transcript:
1CT - Anatomy and Pathology of Uterus and Ovaries Migdalia OrdonezOHSUSummer 2012
2Purpose of this Presentation Review Pelvic anatomy on CT.Review common Pelvic pathologies on CT.
3Topics to review: (use hyperlinks to jump to different sections) CT basicsNormal AnatomyNon-neoplasmNeoplasms
4CT basicsNormal AnatomyNon-neoplasmNeoplasmFirst, some basic CT Principles you will need for this learning module.
5View the image is as if you were looking up from the patient’s feet. CT basicsNormal AnatomyNon-neoplasmNeoplasmCT BasicsRightLeftView the image is as if you were looking up from the patient’s feet.
6CT Basics > > > > Normal AnatomyNon-neoplasmNeoplasmCT Basics>>>>Metal Bone Water Fat Air (tissue and blood)+500 to HU to -500 HU HU to -50 HU to HUThings appear whiter according to their relative densities.This property is called “Attenuation” and it is quantified in Hounsfield Units (HU), which can be measured on CT viewing software.
7Quick review Is it metal, bone, water, fat, or air A. _______ CT basicsNormal AnatomyNon-neoplasmNeoplasmQuick reviewIs it metal, bone, water, fat, or airA. _______B. _______C. _______D. _______C.D.B.A.
8Answers Is it metal, bone, water, fat, or air A. Muscle B. Bone C. Air CT basicsNormal AnatomyNon-neoplasmNeoplasmAnswersIs it metal, bone, water, fat, or airA. MuscleB. BoneC. AirD. FatC.D.B.A.
10Identify structures in next slide: CT basicsNormal AnatomyNon-neoplasmNeoplasmIdentify structures in next slide:
11CT basicsNormal AnatomyNon-neoplasmNeoplasmIdentify structures Landmarks: Ovaries usually lateral to uterus and inferior to bifurcation of Iliac vessels CABCDEFG
12Identify structures A B C D E F G Bladder Piriformis muscle CT basicsNormal AnatomyNon-neoplasmNeoplasmIdentify structuresABCDEFGBladderPiriformis muscleRight ovaryRectumLeft ureterPsoas muscleUterine body
14Side note: This is a… Hysterosalpingogram CT basicsNormal AnatomyNon-neoplasmNeoplasmSide note: This is a…HysterosalpingogramRadio-opaque material is injected into the cervical canal.Procedure is used to investigate the shape of uterine cavity and shape and patency of fallopian tubes.Included here to review anatomy
16Pathology – Non-neoplasm CT basicsNormal AnatomyNon-neoplasmNeoplasmPathology – Non-neoplasmDescribe what you see:Attenuation (density)Heterogeneous v. HomogenousWell-circumscribed v. Indistinct BordersEnhancing (lights up with contrast) v. non-enhancingLocation
17CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #128 year old female presents with fever, lower abdominal pain, new vaginal discharge and complaints of painful intercourse.Physical exam: Febrile and cervical motion tenderness.A computed tomography (CT) was done, see next slide.
18CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
19Pelvic Inflammatory Disease CT basicsNormal AnatomyNon-neoplasmNeoplasmEnlarged uterus of soft-tissue attenuation, flanked at the posterior aspects by tortuous, thick-walled oviduct Left greater than Right filled with material of fluid-attenuation.Pelvic Inflammatory Disease
20CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #236 year old female presents with sudden onset bilateral pelvic pain, left side worse than right. History of pelvic inflammatory disease a year ago treated with antibiotics.Physical exam: Tender to palpation in bilateral lower abdomen, L greater than R. Entire pelvis tender to palpation.A computed tomography (CT) was done, see next slide.
21CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
22Coronal view - Describe what you see: CT basicsNormal AnatomyNon-neoplasmNeoplasmCoronal view - Describe what you see:
23CT basicsNormal AnatomyNon-neoplasmNeoplasmLeft pelvis there is a cystic lesion with heterogeneous enhancement.The lesion appears to be contiguous with the uterus, likely representing…Tubo-ovarian abscess
25CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #323 year old female presents with fever, chills, lower abdominal pain, recent history of PID treated with antibiotics.Physical exam: Febrile and cervical motion tenderness.A computed tomography (CT) was done, see next slide.
26CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
27CT basicsNormal AnatomyNon-neoplasmNeoplasmUterus has large, heterogeneous mass with areas of soft-tissue attenuation and areas of fluid attenuationTubo-ovarian abscess
28CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #423 year old female presents to ED by ambulance due to motor vehicle accident. She is complaining of lower abdominal / pelvic pain.Physical exam: Pelvis tender to palpation.A computed tomography (CT) was done, see next slide.
29CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
30IUD Highly attenuated object in uterus, otherwise normal pelvic CT CT basicsNormal AnatomyNon-neoplasmNeoplasmHighly attenuated object in uterus, otherwise normal pelvic CTIUD
31CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #521 year old female with 2 days of progressively worsening pelvic pain. She missed last period. She has been feeling nauseated for past 3 weeks.Physical exam: right pelvic tenderness, breast tenderness.A computed tomography (CT) was done, see next slide.
32CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
33Contrast enhanced axial CT image shows strong enhancing ring-like mass (arrow) that represents gestational sac without hemoperitoneumCT basicsNormal AnatomyNon-neoplasmNeoplasmEctopic pregnancy
34Pathology - Neoplasm Describe what you see: Attenuation (density) CT basicsNormal AnatomyNon-neoplasmNeoplasmPathology - NeoplasmDescribe what you see:Attenuation (density)Heterogeneous v. HomogenousWell-circumscribed v. Indistinct BordersEnlarged v. atrophiedEnhancing (lights up with contrast) v. non-enhancingLocation
35CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #613 year old female presents with abdominal discomfort and feeling bloated. Stomach seems to be growing wider.Physical exam: Increased abdominal girthA computed tomography (CT) was done, see next slide.
36CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
37(Mature dermatoid cyst) CT basicsNormal AnatomyNon-neoplasmNeoplasmMid pelvis there is large, thin-walled, cystic structure of fluid-attenuation.At the periphery of this structure are a few distinct regions of heterogeneous tissue.Within the right lateral aspect lies a foci of bone-density material.Within the left lateral aspect lies a heterogeneous foci of fat and soft-tissue densitiesTeratoma(Mature dermatoid cyst)
38CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #748 year old female was involved in motor vehicle accident. She is shaken up from accident but otherwise feeling fine.Physical exam: Pt is in no acute distress. No signs or symptoms of pain. Patient insisted having a CT to rule out bleeds.A computed tomography (CT) was done, see next slide.
39Describe what you see: Clue: this arises from the ovary CT basics Normal AnatomyNon-neoplasmNeoplasmDescribe what you see:Clue: this arises from the ovary
40Serous Cystadenoma (benign) CT basicsNormal AnatomyNon-neoplasmNeoplasmPosterior aspect of the pelvis lies a well-circumscribed, thin-walled, non-septated cystic structure containing fluid-density materialClue: this arises from the ovarySerous Cystadenoma(benign)Incidental finding on CT
41CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #858 year old female presents to clinic with bloating, back pain, urinary urgency, constipation, and tiredness for 6 months. Recently she developed pelvic pain, vaginal bleeding, and unintentional weight loss.Physical exam: Abdomen tender to palpation throughout. Pelvic tenderness.A computed tomography (CT) was done, see next slide.
42Describe what you see: Clue: This arises from the ovary CT basics Normal AnatomyNon-neoplasmNeoplasmDescribe what you see:Clue: This arises from the ovary
43Cystadenocarcinoma (Malignant) CT basicsNormal AnatomyNon-neoplasmNeoplasmThe pelvic cavity is grossly distended by multiple well-circumscribed, thin-walled, septated, lobular structures of fluid-density.These structures are compressing but don’t seem to invade surrounding pelvic tissuesCystadenocarcinoma(Malignant)Note: Septations and lobulated surface
44Sources As well as IMPAX, EPIC, and WIKIPEDIA CT basics Normal Anatomy Non-neoplasmNeoplasmSourcesSiddall KA. Multidetector CT of the female pelvis. Radiol Clin North Am. 01-NOV-2005; 43(6):Casillas J, Joseph RC, Guerra JJ Jr. CT appearance of uterine leiomyomas. Radiographics Nov;10(6):Foshager MC, Walsh JW. CT anatomy of the female pelvis: a second look. Radiographics Jan;14(1):51-64;Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics Mar-Apr;21(2):Pannu, HK, et al. MD CT Evaluation of Cervical Cancer: Spectrum of Disease. Radiographics 2001; 21:1155–1168Rha SE, et al. CT and MR imaging features of adnexal torsion. Radiographics Mar-Apr;22(2):Roberts JL, Dalen K, Bosanko CM, Jafir SZ. CT in abdominal and pelvic trauma. Radiographics Jul;13(4):Roobolamini, SA. Imaging of Pregnancy-related Complications. Radiographics 1993; 13:Saksouk FA, Johnson SC. Recognition of the ovaries and ovarian origin of pelvic masses with CT. Radiographics Oct;24 Suppl 1:SSam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics Nov-Dec;22(6):Yang DM. Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics Sep-Oct;24(5):Buy, J-N, et al. Cystic Teratoma of the Ovary: CT Detection. Radiology 1989; 171:As well asIMPAX, EPIC, and WIKIPEDIA